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The quality of nursing documentation is an important issue for both patients and nurses.  Obviously quality nursing documentation enhances patient care as this leads to better communication of the issues. When reviewing the medical record, the plaintiff’s attorney looks for facts to prove each of the four elements of the case (duty, breach of duty, causation, and damages). Some of pitfalls in documentation have been eliminated by the introduction of EMR (electronic medical records) but not all institutions have fully integrated these types of systems yet and the EMR systems have come with their own set of problems. Do you want to sharpen your skills in understanding the intricacies of electronic medical records (EMRs)?
Are you an attorney who needs to probe the details of an EMR but doesn’t know what information is hidden? The following is from a case a recently reviewed.  The patient was admitted a fall and short term loss of consciousness.
MEDICAL MALPRACTICE: IS IT POSSIBLE FOR THIS TO BE CAUSED BY SYSTEM FAILURES AND HOW DOES ONE REVIEW THIS TYPE OF CASE? Documentation is an integrated component of the process of developing a nursing care plan that is initiated by the appropriate nursing personnel.
For demonstration purposes, the abbreviated medical history below is appropriate for all examples (Figs. Figure AppD-1A addresses the three major NANDA diagnoses, which are numbered in the NANDA Diagnosis column.
Each NANDA diagnosis would be addressed separately using the APIE format based upon the nursing assessment, the care plan, and the NANDAs. With charting by exception, the nurse generally starts by working with a standard systems flow sheet (Fig. Figure AppD-5 shows a graphic flow sheet that indicates multiple areas of routine charting. FIGURE 2 · Example of problem area (focus) charting: SOAP (subjective, objective, analysis, plan). FIGURE 3 · Example of problem area (focus) charting: APIE (assessment, problem, implementation, evaluation). An estimated 30 million Americans are expected to gain health insurance through the Affordable Care Act (ACA), and a healthy and sizable workforce will be needed to meet the increased demand.
Health care workers are facing mounting stress and instability as the Affordable Care Act forces industry changes that overburden health professionals, leading to increased dissatisfaction, burnout, and the loss of care providers.
Congress and the President passed legislation that reduces payments and increases penalties, pushing health care providers to the brink of insolvency, further risking accessibility for all Americans. The Affordable Care Act of 2010 (ACA) is projected to expand health insurance coverage to an estimated 30 million to 34 million people.
Despite the best efforts of medical professionals and educators to increase the workforce over the past few years, shortages are projected in every health care profession. Based on a 2012 compilation of state workforce studies and reports, every state clearly needs more physicians.
The ACA reauthorized loan repayment and forgiveness, scholarships, increases in Medicare-funded Graduate Medical Education (GME) residency slots, funding for workforce planning, and increased funding for the Public Health Service. The danger is that these shortages will result in increased morbidity and mortality for rural Americans. The ACA relies heavily on the concept of the Patient Centered Medical Home (PCMH) model and free preventive care. Younger physicians exhibit different attitudes toward their professional roles and responsibilities. The American Association of Medical Colleges is supporting legislation to increase the number of Medicare-funded residency slots, but even if the President signs the legislation, the shortfall of residency slots will persist at least through 2017.[33] Even if medical schools can graduate more students, the lack of residency slots prevents graduates from practicing medicine. Without a strong and growing workforce operating under better working conditions, the quality of patient care will not improve.
Increased medical errors from fatigue, poorer outcomes, and even patient death are a direct result of workforce stress and heavy workloads.[38] Historically, vulnerable populations with complex medical conditions, such as the elderly and African Americans, are affected more.
Since 1997, the federal government has issued 100 new or revised federal health care regulations, and this does not include countless state and local regulations.
With the new regulations, lower reimbursement rates, and required investments in technology, health care institutions and medical professionals will have difficulty breaking even. The new pay-for-performance standards will significantly affect hiring and retention of labor.
In a recent survey, one-third of physicians would not choose medicine if given the choice to do it over again, and almost 60 percent would not recommend medicine as a career.[52] Physician well-being is directly correlated with the ability to provide quality of care to patients. The Obama Administration all but rescinded the Bush Administration’s initiatives to protect health care workers. ACA legislation creates a barrier to Medicare’s physician–patient relationship through the Independent Payment Advisory Board defining what treatments can or should be funded and insurance companies and government program officials determining what treatments are allowable. With the ACA-based contraceptive mandate and states considering measures to force health care workers to provide services regardless of moral objections, Americans have every reason to worry about efforts to violate the right to religious freedom and the right of conscience.[61] The health professions require workers to adhere to a code of ethics and to maintain the highest moral and ethical standards.
In response to increased regulatory burdens, health care stakeholders are changing business practices. While alliances help to increase quality and efficiency through coordination of care, some argue that consolidation and mergers can also lead to monopolies in the marketplace. Physicians are selling practices, moving into larger physician groups, and seeking employment at hospitals. An estimated one-third of physicians were anticipated to move to such a subscription-based practice model by the end of 2013. In most cases, patients are expected to retain insurance to cover fees for the physician’s basic services. With subscription-based models, physicians can opt to limit or reduce the panel of patients allowing for individualized, unhurried care with a guaranteed baseline income. The ACA approach to guaranteeing quality is to move the medical workforce from the fee-for-service model of health care reimbursement to pay-for-performance.
While the concept of pay-for-performance shows some merit in reducing cost, transforming the system could prove difficult with the current penalties and reductions in reimbursement rates.
Although many residents of urban areas may feel only a slight change, Americans living in more rural locations will bear the brunt of the shortage. While many Americans will purchase insurance on heavily regulated exchanges, insurance itself does not guarantee access to or quality of care.
The ACA requires millions of Americans to enroll in health insurance, but the care delivery system is unprepared to absorb the influx of Americans seeking care. Educational financing should reflect a better balance between primary care and specialty practices, increasing graduates of all health professions and providing financial incentives for faculty. Medical and professional colleges should adopt admissions criteria that attract students from rural areas, and the curriculum should address the challenges of practice in a rural environment. As with many other areas of public policy, Congress should refrain from assuming responsibilities that are best left to state legislators, particularly where state nursing shortages are acute. Entrenchment of professional organizations has undercut reform in many states, even though the looming shortages will necessitate the full use of APRNs and other non-physician providers.
Finally, health care workers should not be forced to choose between following their moral conscience and obeying potentially immoral orders of their superiors.
Health care policy is no longer abstract when it directly affects the personal lives and health of millions of Americans. Sensible changes in health care policy could fix the problems of the few without harming the care of the many. There is no shortage of policy prescriptions for rational and profoundly consequential health care reform: portability of insurance, price transparency, tax reform, tort reform, deregulation, payment reform, and the elimination of artificial barriers to coverage and care.
Studies have shown that large babies have a higher rate of complications that can lead certain to, fetal, neonatal, infant, and long-term injuries and disabilities. The risks of high birth weight can be reduced and even eliminated with appropriate medical treatment.
A baby whose weight is in the 90th percentile for his or her gestational age is generally considered to be a “large baby.” There are number of factors that can lead to higher-than-normal birth weights, including maternal age, weight and diabetes. Larger babies are at greater risk for certain complications that can lead to brain injuries during birth. These can result in decreased oxygen supply (hypoxia) and decreased blood flow (ischemia) to the baby’s brain, which can lead to brain damage. In addition, complications such as placental abruption are more common for older mothers – especially after age 40 – and therefore may be more common among larger babies as well. Due to the increased risks associated with higher birth weights, induction and augmentation of labor can in appropriate circumstances be the safest options for large babies.
If your baby suffered a brain injury during delivery or is experiencing developmental delays or other signs of brain damage, it is important to speak with someone right away. Brief description of your question or issue*CommentsThis field is for validation purposes and should be left unchanged. Online clinical decision support guides physicians to prescribe the best medication – and the right dose. PYXIS Profile ensures that patient meds are verified by a pharmacist and that nurses remove the correct medication from the machine. With BCMA in place, the nurse will scan the barcode on each of the medications before adminstering to the patient.
Once the patient takes the medication, the nurse will click ‘done’ and the system will automatically update the patient’s medical  record. Because bar code medication administration depends entirely on electronic scanning, getting the program up and running has been a complex process, said Paul Miranda, RPh, MBA, associate director of Pharmacy.
To begin with, each dose of a medication order requires a bar code that Sunrise recognizes or it won’t work on the patient floors. Pharmacy is also working to keep the number of required scans when dispensing the med to a minimum. Photo caption: As Colleen Mallozzi, BSN RN, BSIS, manager of Nursing Informatics, demonstrates, each medication given to a patient will need to be scanned, as part of bar code medication administration. Or, if you've received an email edition recently, use the "update your preferences" link at the bottom of the email or contact us to subscribe. Make sure to date, time, and authenticate each entry with your signature and professional credentials as close as possible to the time you performed an assessment or intervention. These reflect poorly on the     nurse and undermine the nurse’s credibility in front of a jury.
Computerized templates of forms or hard copy pen-and-paper preprinted forms can be used, depending on the individual facility needs, resources, and requirements. The documentation is written as a narrative as the events occurred (ie, narrative chronological charting). For instructional purposes using this example, the NANDA diagnoses are also in bold italics within the charting. At the time of the collection of data, the nurse also discovers significant abnormal findings related to nausea, abdominal distention, and pain. AppD-4A), which indicates most normal findings according to body system (neurologic, cardiovascular, and so forth) or other organized, preprinted format.

Gastrointestinal tissue perfusion ineffective related to mechanical blockage of peristalsis as manifested by hyperactive bowel sounds RUQ, absent bowel sounds in remaining quadrants, and acute, severe abdominal pain and nausea. The health care workforce is already facing a critical shortfall of health professionals over the next decade.
However, expansion of coverage is not an expansion of actual care, and the distinction is becoming clear.[2] When Congress enacted the national health law, it unleashed a potential tsunami of newly insured patients, flooding a delivery system that was already strained and fragile. Pent-up demand from those waiting for a plastic card and attracted by the promise of “free” or heavily subsidized services is expected. The projected supply of workers fails to meet the demand associated with population growth and aging of the population. These are intended to reduce the rural shortages, but these programs have historically achieved only limited success.
Solving the problem will likely require a paradigm shift in educational admission practices, recruitment of more personnel with rural experiences, payment reform in the public and private sectors, and a much friendlier regulatory environment for medical practice, including tort reform. Another personnel supply problem is the disproportionate ratio of primary care physicians to specialists. A recent workforce survey described physicians over the age of 50 as more dedicated and hardworking and their younger counterparts as disillusioned, less dedicated, and not as hardworking.[23] If this survey accurately reflects the younger workforce, physician productivity will likely decrease with increased retirements. In 2010, the Institute of Medicine (IOM) published a report recommending that all nurses practice to “the full extent of their education and training.”[25] Advanced practice registered nurses (APRNs) are not just NPs educated in primary care, but trained professionals who provide services in multiple specialties. Seventeen states and the District of Columbia allow full practice by APRNs without oversight by physicians. Currently, medical education institutions are unable to graduate the number of workers needed to guarantee broad access to medical care.
More than 79,000 qualified applicants were turned away from nursing programs in 2012.[34] Complicating matters, the average salary for positions in nursing education is significantly lower than what these experts can earn outside academia, making it difficult to recruit and retain key academic personnel. The average age of associate nursing professors is 52, and the average assistant professor is 49, while the average age of medical school faculty is between 50 and 59.[36] Retirements are on the horizon, and any additional losses of faculty will increase the backlog in the educational pipeline. Health professionals worry about the ACA’s impact on their workforces, and many are considering alternative careers and opportunities.
With millions of people entering the ranks of the insured combined with the decline in the growth of the health care workforce, doctors, nurses, and other medical professionals should expect their workload to increase dramatically. Heavy workloads can even increase health care disparities.[39] With the newly insured under the ACA anticipated to increase the number of patients in the system with complex medical issues, meeting their needs will require a significant investment of human capital. In addition to the sheer number of new patients in the system, the ACA intensifies the regulation of an already overregulated system. Health care professionals went into medicine to help people, not to fill out government forms. The ACA relies heavily on mandates, penalties, and bonus reimbursements for compliance with its regulatory standards. If facilities cannot improve their quality scores, the reduced reimbursements will mean budget cuts, shutting down units and even closing hospitals.
Working in health care is difficult with adequate personnel, much less with the anticipated shortfall of workers.
With physician dissatisfaction increasing the likelihood of doctors leaving the profession by two to three times, Americans can expect additional labor losses.[53] The outlook is grim. Many health care professionals are concerned with profound moral and ethical issues that periodically arise in the health care field and worry about their traditional ability to exercise their rights of conscience under the ACA. Thus, in many concrete circumstances, workers with religious or moral objections to certain medical treatments or procedures are left without specific, explicit protections, and the Obama Administration has thus far blocked legislation that attempts to correct the problem. Meanwhile, HHS has blatantly disregarded right of conscience by mandating insurance funding of abortion-inducing drugs, contraception, and sterilization.[58] Right-of-conscience supporters have focused on reproductive rights and the rights of the unborn child, but the ethical concerns are broader. Right of conscience is supported by 63 percent of the American public, and 87 percent agree that health care workers should not be forced to participate in procedures that go against their moral conscience. Health care workers are voicing growing concern over the implication of these barriers to ethical patient care.
Without explicit legal protections, health care workers will be forced to choose between violating their personal moral and ethical beliefs or losing their jobs. Ensuring viability in the new marketplace requires strategic planning and a vision of the future.
Hospitals, individual physicians, group practices, and other health care businesses are merging and consolidating to remain strong in the marketplace.
Frustrated with increased regulation, the financial costs of practice, liability, continually increasing workloads, and the overall stress of the workplace, physicians are choosing to forgo independent practice.
Legitimate concerns about the workforce shortage, burdensome regulations, reduced time with patients, and government involvement in the physician–patient relationship have prompted health care providers to begin changing independent practice models.
Direct pay and “concierge care” are subscription-based models in which patients pay a monthly or annual fee.
In fact, some insurance companies are building plans for employers that allow individuals to purchase the concierge option for increased access and payments.[71] While the cash-only, concierge care, and subscription-based models all attempt to safeguard the individual rights of the provider and patient while mitigating financial loss, the increasing number of these practices will affect affordability and accessibility for Americans. Adding up to 34 million patients to an insurance and delivery system that is already struggling with workforce shortages cannot avoid adversely affecting patient access and quality of care. The Office of the Actuary in the Centers for Medicare and Medicaid Services, among others, has already projected that more hospitals will be operating in the red or hovering on the brink of insolvency. Greater access to health care is a central ACA goal, but heavier demand for services will likely create a bottleneck in access. Exchange plans with narrow networks invariably mean limited access to specialists and world-class treatment programs. The ACA’s new pressures will exacerbate attrition from burnout and dissatisfaction, worsening the existing shortage. If medical and other health care students seek relief to reduce the financial burdens of their professional education, they should expect to serve persons in areas with serious shortages of medical personnel. Admissions officers should identify students from rural areas and those planning to practice in rural areas or primary care. It is imperative to ensure available residency slots for the projected medical student enrollment.
Programs funded through this initiative have contributed to an overall increase in the number of faculty and graduates of nursing schools.[90] Congress should evaluate the ACA’s Graduate Nurse Education (GNE) pilot program before providing additional funding. In these cases, state legislators should set priorities and fund, as appropriate, nursing schools in their states based on their citizens’ needs. Scope-of-practice rules can contribute to the cost and inefficiency of the health care system, creating another barrier to patient access to care. Insurance companies and government agencies should remove obstacles to certification, eliminating payment issues.
Workforce shortages compel health care leaders to invent new ways to use limited personnel efficiently to meet increased demands. Congress can contribute to workforce well-being by enacting legislation that explicitly guarantees the right of conscience and protects health care workers. The emerging health care workforce shortage, while rooted in trends that preceded the ACA, is not alleviated by the new health law. With the rocky start to the exchange enrollment, the reduction in health plan competition in the exchanges, the emergence of narrow networks of doctors and other medical providers, and the rate shock of higher premiums and deductibles, more Americans oppose the new health law than support it. Under the ACA, Congress has prescribed a detailed federal role over health care financing, but financing directly and immediately affects the delivery of health care and how Americans access that care.
Health care reform legislation should follow the principle primum non nocere (“first do no harm”) by carefully targeting the root of the problem, not by granting vast regulatory power to unaccountable government officials who issue arbitrary edicts.[100] Every day the ACA is the “law of the land” risks permanent damage to the health care sector of the economy and the lives of Americans. Vaughn et al., “Can We Close the Income and Wealth Gap Between Specialists and Primary Care Physicians?” Health Affairs, Vol. Niecko-Najjum, “Building a Health Care Workforce for the Future: More Physicians, Professional Reforms, and Technological Advances,” Health Affairs, Vol. Cooper, “States with More Physicians Have Better-Quality Health Care,” Health Affairs, Vol.
Department of Health and Human Services, National Center for Health Workforce Analysis, The U.S. One of the greatest concerns associated with high birth weight is the increased risk of brain damage due to complications during delivery.
However, when doctors, nurses, and hospitals commit errors during labor or delivery, the results can be severe. In addition, under normal circumstances, babies continue to grow as long as they are in the womb, so overdue babies are more likely to be larger – even if their weight is not otherwise outside of the typical range. In addition to the conditions mentioned above, these can include problems with the mothers’ blood pressure, neonatal anemia, infections, preeclampsia and eclampsia, and trauma during delivery. However, induction and augmentation – facilitated by the drug, Pitocin – carry their own risks as well. On the other hand, medical errors during induction can have drastic consequences, including brain injuries.
Your baby’s condition may be the result of a medical error, and you may be entitled to significant compensation to cover your medical expenses and other losses. Sunrise will verify the ‘five rights’ --  right medicine in the right dose at the right time by the right route and the right caregiver.
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I personally know Pat Iyer and she shares her knowledge and expertise graciously with others. Nursing diagnoses (NANDAs) are integral parts of the nursing process and need to be reflected in your facility’s documentation and record-keeping formats.
The NANDA diagnoses are developed from this medical history and from an initial comprehensive admission nursing assessment, which is not provided here. Notice  how the numbered NANDAs, from the abbreviated medical history above, are integrated into the assessment.
Other ways of documenting charting errors are to write recorded in error or mistaken entry and your initials. The ACA breaks the promises of access and quality of care for all Americans by escalating the shortage and increasing the burden and stress on the already fragile system.
The American health care infrastructure has had workforce shortages for decades and is not prepared to meet such a vast influx of patients effectively or efficiently. Of course, doctors, nurses, and other medical professionals want to help people in need, but the sheer logistics of expanded care delivery, the current and growing shortage of personnel, and limited resources will certainly undercut the good intentions of the policymakers who crafted the national health law. With the new demand for medical services for the millions who are expected to enroll in Medicaid and the federal and state insurance exchanges, the workforce shortages could become catastrophic.
Before the ACA’s enactment, a confluence of pressures had contributed to labor force problems. In much of the nation, health professionals are highly concentrated in urban locations.[7] The federal government established Health Professional Shortage Areas (HPSAs) in 1976, pursuant to congressional enactment of the Health Professions Educational Assistance Act, to increase the number of health care workers in rural and underserved areas. Research suggests that the ideal ratio of specialists to primary care physicians is 40 percent to 50 percent in the healthiest nations.[12]A large gap in this ratio currently exists, with only one-third of physicians working in primary care. Another 21 states authorize reduced practice by allowing APRNs to practice in collaboration with a physician, and 12 states restrict practice requiring collaboration, oversight, and supervision by a physician.[27] The workforce shortage issue will require states to reexamine their scope-of-practice laws.

Even with recent enrollment increases, demand will still outweigh the supply by 2025.[28] The training pipeline is backlogged, and qualified applicants are not gaining entrance to professional schools.
Increased safety issues and greater stress on workers will inevitably increase work demands.[37] The ACA’s financial incentives for and penalties against doctors and other medical professionals are to be tied to quality and performance metrics, but with the diminished workforce, maintaining the sufficient ratios to ensure quality care will be difficult.
The enormous paperwork requirements will reduce time spent with patients and significantly increase the costs of providing care.
Every minute and dollar spent on paperwork is a minute and dollar taken away from patient care. Even with attempts to improve performance over the past few years, 2,225 hospitals were penalized in 2013 under the Hospital Readmissions Reduction Program (HRRP), part of the ACA legislation. Increased work-related stress will affect the mental and emotional health of medical professionals. The marginalization of physicians and practitioners created by ACA legislation compromises safety and increasingly infringes on the ethical and moral obligations defined by the medical professions. Without legislative guarantees and enforcement provisions, health care workers face discrimination.
A reevaluation of market standing, labor costs, and current infrastructure is essential to ensuring solvency as the ACA is implemented. Mergers and acquisitions reduce overhead costs for billing and claims while spreading out the financial risk and increasing market share. Cash-only practices are popping up around the country with many posting price lists and requiring up-front payment for services. The HHS has warned about such practices in the past, and as the market for alternative access increases, there is concern that government will intervene to restrict or prohibit such practice models. The ACA cannot by itself guarantee access or increased quality of care through the mandated purchase of all-inclusive insurance policies. Individuals on the exchanges will likely experience a narrowing of networks and limited providers. Patients can lose choices in treatment and care.[86] Hospitals are closing, and rural hospitals and critical access facilities are increasingly at risk for closure. Many problems are endemic to professional training, and the terms and conditions of training and education should remain the responsibility of the professions. Health professionals should incorporate interprofessional education to increase efficiency and productivity, promote coordination of care, and hold training exercises in teamwork.
GME strategic planning should focus on rural and underserved communities and create additional slots for specialties with the highest projected shortages, such as primary care.
Future GNE programs should consider emphasizing rural education and primary care specialties to target specific distribution and shortage problems. Kirch, MD, chief executive officer of the American Association of Medical Colleges, recently stated that the medical community needs to train an additional 4,000 doctors per year “while also embracing the roles in which other professionals can serve.”[94] The impending shortage and the aging population demand a hard look at innovative models of care. State legislators should examine the potential role of APRNs as a way to increase access and achieve additional savings. Providing health care is labor intensive, and recruiting and retaining a sufficient workforce are essential. Incentives should include a mix of public policies, such as reducing liability through tort reform, Medicare payment reform, and reduced federal tax rates.
Meanwhile, states should consider legislation that protects patients and workers from heavy workloads in state hospitals and other publicly funded institutions. If these trends continue, they will become an insurmountable obstacle to the ACA’s success and damage the quality of care for millions of Americans.
If these initial problems turn into cascading failures accompanied by massive disruptions of existing coverage and care, Congress will be forced to act.
Thus far, the ACA has delivered higher health insurance premiums, higher deductibles, and less competitive health insurance markets. Auerbach et al., “The Nursing Workforce in an Era of Health Care Reform,” New England Journal of Medicine, Vol. Aiken et al., “Hospital Nurse Staffing and Patient Mortality, Nurse Burnout and Job Dissatisfaction,” JAMA, Vol. Shanafelt, “Physician Burnout a Potential Threat to Successful Health Care Reform,” JAMA, Vol. Cerebral palsy, developmental delays, speech impediments, learning disabilities, paralysis, and even death have all been linked to brain injuries suffered by large babies during birth. When a doctor fails to diagnose a condition that creates an increased risk for brain injuries, this is a mistake that can give rise to a claim for medical malpractice. Many of these errors are associated with improper administration of Pitocin during the delivery process.
To learn more about what an experienced medical malpractice attorney can do to help, please contact us today. If any of these conditions are not met, “the screen will show an alert,” explained Terese Kornet, MSN, RN, director of Clinical Nursing Systems.
The basic nursing process consists of the assessment, identification of NANDAs, plans with specific goals, interventions or implementations, and the evaluation of each plan or goal. The ACA’s attempts to address the shortage are unproven and limited in scope, and the significant financial investment will not produce results for years due to the training pipeline. Training new physicians, nurses, and other health professionals takes years, sometimes decades.
In fact, the “transformational” changes touted by the law’s champions will likely complicate and negatively affect health care workers and their ability to provide care. Americans are living longer than ever before with the help of breakthroughs in medical technology and advanced care management. In terms of work flow, this means the number of medical professionals needed to care for a patient depends on the gravity or nature of the patient’s medical condition. Part of the problem is the overwhelming complexity of implementing the massive law, requiring them to meet new legal requirements while fulfilling professional obligations and meeting professional expectations for high performance in delivering patient care. The penalties totaled more than $227 million, and facilities located in poor regions where a higher proportion of low-income patients are treated were hardest hit.[48] With the HRRP and the reduction of Medicaid Disproportionate Share Hospital (DSH) payments, providers are experiencing significant cuts in revenue while trying to increase quality of care to meet or maintain the ACA’s benchmarks. This gives them greater negotiating power with insurers, other hospitals, physicians, and government entities.[62] Horizontal and vertical consolidation in 2011 included 432 mergers involving 832 hospitals.
While the number of cash-only practices is small, practice conversions have been rising for the past few years. Concierge practices provide a higher level of service including care coordination and helping patients to negotiate the system while direct-pay practices provide more limited services, such as same-day appointments and additional access to doctors via phone or e-mail.[69] Patients pay a practice or membership fee with a contract between the physician and patient guaranteeing priority access and services added to basic care.
In fact, the unintended consequences of the ACA’s complexity will ripple throughout the health care sector.
In a survey by Jackson and Coker, 44 percent of physicians indicated that they will not participate in the exchanges.[79] A survey by the Medical Group Management Association found that 64 percent of practices are concerned with the regulatory burdens, and two out of three practices indicated that reimbursement rates were lower than commercial rates, heightening concern about participation. The triple aim of increased quality and satisfaction, reduced costs, and increased health can be guaranteed only with an efficient workforce that is large enough to accommodate the needs of a growing and aging population.[88] Solutions to the existing problems will require innovation in medical education and training, improved delivery of care, and implementation of policies to retain the existing health care workforce.
Increasing worker productivity will require strategic planning and partnerships to increase output of highly competent providers of care while addressing the maldistribution and disproportionate ratio of health care workers.
Nursing educators need to streamline the curriculum to ensure that students are ready for work when they graduate.
Given the current critical juncture of demand and supply of medical services, it is essential to ensure that all hands are on deck to care for the surge of patients.
Strengthening the workforce supply should be coupled with innovation in role and task allocation.[96] Efficiency and productivity will expand the workers’ capacity to deliver high-quality patient care. In the private sector, health care businesses will need to use the most effective methods of attracting, hiring, and retaining workers.[99] Retaining talent will require extensive human resource planning and incentivizing through benefits, education and career advancement, profit sharing, and workforce protections. This does not bode well for care delivery, particularly if it means increased waits, rationing of care, limited or no access, and poor quality of care.
Buerhaus, “Health Care Reform and the Health Care Workforce—The Massachusetts Experience,” The New England Journal of Medicine, Vol. Before being induced, it is important to have your doctor explain all of the potential risks involved. Her history includes a cerebrovascular accident 2 years ago, resulting in weakness of the left leg.
With the ACA’s estimated 190 million hours of paperwork annually imposed on businesses and the health care industry, combined with shortages of workers, patients will be facing increasing wait times, limited access to providers, shortened time with caregivers, and decreased satisfaction. Without more graduates from nursing and medical schools and increased innovation in shared roles and responsibilities among doctors, nurses, and other medical professionals, individuals and families will face longer wait times, greater difficulty accessing providers, shortened time with providers, increased costs, and new frustrations with care delivery.
These changes will increase regulatory burdens, increase already heavy workloads, reduce payments, impose new penalties, and disregard personal preferences and values. Seniors currently account for 12 percent of the population but will account for 21 percent by 2050.
As the population ages, the number of patients suffering from chronic diseases will increase significantly, requiring additional labor hours to ensure quality of care. While physicians escaped a reduction in Medicare reimbursement rates in 2013, a 25 percent reduction is scheduled for 2014.[49] Under current law, physicians are unlikely to avoid the payment rate reductions, endangering their financial margins.
Physicians who follow this route significantly reduce overhead costs by eliminating patient billing and claims, freeing them to set their own prices and care for the patients in the manner that they see fit.[68] No insurance company or third party interferes with their decisions about treatments or care. Active interventions to prevent work overloads and strategies for stress management will reduce attrition and costly replacements and ensure adequate supply.
Americans’ private lives and their health decisions should be spared the consequences of such incompetent intrusions.
Primary Care Workforce Shortage,” National Institute for Health Care Reform Policy Analysis No. You advise her that the patient is stable, but you leave without documenting your administration of the medication. She was admitted to the acute care facility 2 days ago with a diagnosis of left lower lobe pneumonia. The health care workforce is facing increased stress and instability, and a major redesign of the workforce is needed to extend care to millions of Americans. Workers need to be protected physically, emotionally, and psychologically to ensure a healthy workforce.
Juraschek et al., “United States Registered Nurse Workforce Report Card and Shortage Forecast,” American Journal of Medical Quality, Vol. These factors combined will threaten access and quality of care for all Americans, thus breaking the President’s promises and the stated intentions of those in Congress who enacted the national health law.
Please do not send any confidential information to us until such time as an attorney-client relationship has been established. Checking the EMR, your colleague sees no documentation of the drug dose you administered before leaving and administers an additional dose of opioid.
Turner, “The Next Phase of Title VII Funding for Training Primary Care Physicians for America’s Health Care Needs,” Annals of Family Medicine, Vol.

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